The cervical spondylosis, also known as cervical syndrome, is a disorder based on degenerative pathological changes. In China, the incidence of cervical spondylosis is increasing. It was reported that the incidence of cervical disease nationwide is more than 20% with computer users, mobile phone users and office workers being at high risk. Besides, the onset of cervical spondylosis tends to occurs at younger ages, with the incidence among primary and secondary school students on a sharp rise. About 30% of patients at Orthopedics Department seek cervical spondylosis treatment.
The lumbar disk herniation (LDH), a kind of disorder in lumbar intervertebral discs named by American Academy of Orthopaedic Surgeons as intervertebral disk bulging, protruded intervertebral disc, extruded intervertebral disc, is a medical condition affecting the spine in which various parts (nucleus pulposus, fibrous ring and cartilage plate) of lumbar intervertibral disc take on degenerative pathological changes of different degrees and fibrous rings are ruptured under the effect of external factors, allowing the nucleus pulposus to bulge out through the rupture, which in turn stimulates or oppresses the surrounding tissues with resulting clinical manifestations of pain, numbness, soreness and other symptoms in waist and legs. It is a one of the common lumbar disorders in clinic, typically occurring in 10% to 15% of orthopaedic outpatients with low back pains and 25% to 40% of inpatients with waist and leg pains. This disease mostly occurs at the ages of 20 to 40 years old, and male patients outnumber female patients. It is shown in literatures that in US the incidence of LDH is 3.1% in male population and 1.3% in female population. Many literatures also reported the epidemiological profiles of LDH in China, and the literatures on Internet indicated an incidence of 15.2%. Many rigorous studies in the past disclosed the incidence in different circumstances. For example, in the Reference 1 [Lu Jun, etc. Investigation on the Prevalence of Lumbar Disk Herniation in the Aircrew at Guangzhou Areas of China Southern Airlines, Chinese Journal of Aerospace Medicine, 2008, (1) 62:132], 132 LDH patients was identified in the investigated 2495 people, resulting in an incidence of 5.3%; in the Reference 2 [Zhang Qishan, Epidemiological Survey of Lumbar Disk Herniation in Flight personnel, Chinese J. Convalescent Med, 2011 (9): 854-855;] the cumulative incidence of LDH in 757 active flight personnel was found to be 3.17%, which comprises 4.73% in fighters, 5.07% in trainers, 1.06% in bombers and 3.01% in transport aircrafts; in the Reference 3 [Wang Guo-ji, Wang Guo-jun, Peng Jian-min, etc, Epidemiological Survey on the causing factors of Lumbar Disk Herniation, Modern Preventive Medicine, 2009, 36 (13): 2401-2403;] four prefecture-level cities in Hunan Province was found to have a high incidence rate of 7.62% of LDH in various populations; in Reference 4 [Xie Zhaofeng etc. Epidemiological Survey of Lumbar Disk Herniation without symptoms among soldiers in a troop, J Prev. Med Chin PLA, 2002, Vol. 20 (6): 412-414;] the incidence of LDH without symptoms was investigated in a troop to support early prevention and treatment of LDH. This study randomly selected 219 new soldiers showing no symptoms in a troop for lumbar CT scan and found an incidence rate of 33.33% in these soldiers. The history of LDH is associated with gender, age, profession characteristics, trauma history and cold history. Its early intervention is predominated by conservative treatment methods such as bed rest, traction, physiotherapy and drugs. However, currently there is a deficiency in specific drugs and in drug diversity.
The cervical disc herniation (CDH) is also extensively discussed in literatures with an incidence rate being second only to that of lumbar disk herniation. It is caused by the degenerative pathological changes of fibrous ring, nucleus pulposus of cervical intervertebral disc and cartilage plate, in particular nucleus pulposus of cervical vertebrae, when fibrous rings are ruptured under the effect of external factors, allowing the nucleus pulposus tissues to bulge out through the rupture or to extrude into spinal canal, which in turn oppresses the surrounding tissues such as spine nerve roots or spinal cord with resulting clinical manifestations of dizziness, headache, chest distress, palpitation, cervical movement limitation, soreness, pains in shoulder back, numbness and pains in upper limbs, gait disturbance, weakness of limbs and other symptoms and signs, and even life-threatening high paraplegia in the worst case. The incidence of CDH ranks only second to that of LDH among intervertebral disc disorders, accounting for about 40%. It mostly occurs in populations aged 40 years old above with a male-to-female prevalence ratio of 1.4:1 (Reference: Wang wen, Development in the Diagnosis and Treatment of cervical disc herniation, 2012, 18 (3):129).
The cervical spondylosis or LDH, if treated improperly or not timely, may lead to cervical vertebral or lumbar malformation, and with the development of the illness, can result in the deterioration of intervertebral disc herniation, increased nucleus pulposus bulging, deflection in spinal formation, humpback and other complications. In addition, this case will be subject to aggravation of pain in neck or waist, which is more intense during the night, and eventually lead to functional disorders in the flexion and extension of neck or waist with secondary severe symptoms including numbness of limbs, limitation of weight bearing and mobility, which directly influence the work, study and life of patients.
Currently, there are a variety of methods available for treating cervical spondylosis or LDH as follows, for example:
(1) Non-surgical drug treatment: take analgesic drugs and apply analgesic plasters to alleviate local pain;
(2) Partial closure therapy: the partial closure treatment of cervical or lumbar vertebrae consists of acupoint block and regional block, which requires superior techniques;
(3) Open surgery: a) In case of forward disc herniation in cervical segments, this operation may cause damage to the large cervical vascular and nerve, or in case of forward disc herniation in thoracic segments where the surgery must take thorax approach, this operation may lead to a series of sequelae such as mediastinum viscera injury and postoperative hemopneumothorax, pleural adhesion, prolonged chest pain, etc.; b) The surgery for lumbar disk herniation is to excise the pathological nucleus pulposus directly to relief radicular pain. Due to the limitation of particular physical position of lumbar spine, such surgery will cause damage to the normal lumbar physiological structure, which often results in postoperative lumbar spinal instability, postoperative scar tissue adhesions, and accidental nerve injury, and other adverse reactions. Therefore, most patients are afraid of surgery, and the question how to avoid these adverse reactions caused by surgery constantly plagues the medical professions. In general, surgical treatment can be both risky and costly;
(4) Traction therapy which is mainly intended to stretch the ligaments around the cervical and lumbar to ease the pain for a short time by using a special traction device. Nevertheless, the therapy requires special equipment and professional operators, such as SDS non-surgical spinal decompression system, along with the high cost;
(5) Plasmin injection for treating LDH and CDH which has the risk of causing complications. For example, if the drug is incorrectly injected into intervertebral foramen, spinal nerve roots will be injured and in turn lead to numbness of limbs or sensory disability; if the drug is incorrectly injected into spinal canal, severe complications such as acroparalysis may be caused;
(6) Physiotherapy: (6.1) short-wave or ultrashort wave therapy, one time per day, 20-40 mins per time, 15-20 times as one course of treatment; (6.2) diadynamic therapy, one or two times per day, 15-20 times as one course of treatment; (6.3) ultrastimulation electrotherapy. All these physical therapies have the disadvantages of slow recovery, long course, poor effect and dependence on treatment instrument;
(7) Ozone therapy: ozone of high concentration has the effect of astringency and vaporization which is used to treat CDH or LDH. In theory, the injection of ozone can astringe and vaporize lumbar nucleus pulposus. However the entry of ozone into spinal canal will lead to adverse reactions and complications, and the success rate of this therapy is not high;
(8) Microendoscopic discectomy of minimally invasive surgery: in addition to surgical risks and complications, such surgery has one main disadvantage of narrowed operative visual field, making it difficult to clearly and thoroughly excise the pathological nucleus pulposus, thus increasing the risk of operation failure;
(9) Percutaneous atherectomy, having the risk of operation failure, etc.;
(10) Acupuncture treatment, having the disadvantage of high dependency on the personnel medical capacity of the doctor, inconveniency, etc.
Therefore, new treatment approaches or drugs are being searched for constantly to treat or prevent cervical spondylosis, LDH or the like.